Mapping Rwanda public health research (1975-2014).

Background: Since the genocide occurred in 1994, Rwanda has faced up to the challenge of rebuilding. Public health is a main field to understand this rebuilding. Objectives: In this paper, the aim was to map the scientific research on public health in Rwanda after the genocide and to present the links between different financing systems. Methods: We used bibliographic analyses with Web of Science of papers published during the period 1975-2014. We performed analyses on journals, most cited articles, authors, publication years, organizations, funding companies, countries, and keywords. Results: We obtained 86 articles between 1975 and 2014. Most articles were published after 2007. The main countries of research laboratories were the United States of America, Rwanda, England and Belgium and represented the main network collaboration. The relevant keywords were: HIV, woman, child, program, rural and violence. Conclusions: Public health research on Rwanda appeared 14 years after the genocide. A main field was emerging: the spread of HIV with mother-child transmission, and the policies to take this subject into account in rural zones. The network of institutions developing these studies was USA-Rwanda.


Introduction
Twenty years ago, between 800000 and 1200000 people perished according to historical references 1 . In few months, ethnic mass slaughters occurred in all parts of the country.The rebuilding has remained incomplete because of the gigantic tasks in different areas. One of the major areas is public health. In fact, public health represented the needs and demands about population 2 . In low-income countries, public health systems were not suitable to population need; therefore, after genocide and the efforts to rebuild the healthcare structures, the task seemed a major one 3 . Public health covered different fields such as infectiology 4 , parasitology 5 , mental health 6 , organization of the centers and financing movements 7 . After 2008, the World Health Organization presented several programs on public health in Rwanda 8 . After 2010, the main objectives were the fight against HIV, tuberculosis and malaria, the fight against the transmission mother-child 8 , corresponding to the Millennium Development Goals 4-6 .
The aim of this article was to analyze the advancement of scientific publications on public health in Rwanda during the period 1975-2014, and to present the knowledge structures of public health researchers in the world compared to the social situation of Rwanda.

Methods
We used the Science Citation Index-Expanded (SCIE) database, accessed through the Web of Science (WOS) platform from Thomson Reuters. In the advanced search, we obtained the articles by this formula: TS=(public health AND Rwanda). We verified each record to ensure their relevance. The period was1975-2014. The aim was to see any differences before and after genocide (occurred in 1994). Moreover, no restrictions were performed concerning the document types. Then, we performed the "analysis results" function of WOS. We extracted: journals, most cited articles, au- In order to evaluate the research networks between countries, after the analysis by country, we reviewed records of each country and then performed the analysis a second time in order to know the links between the chosen country and the other countries. We then established the diagram.
Finally, we performed several keyword (KW) researches to get the main relevant topics. These analyses are to compare with former bibliometric studies in other fields [9][10][11] .

Results
We obtained 86 records. Only one publication was before 1994 (table1 The funding agencies were numerous and very few from Africa (table 2). We noted 4/70 (5,7%) fundings from Rwanda.

Discussion
According to our analysis, only one study was published before 1994 14  On an international political point of view, this period of publications corresponds to the programs launched by the World Health Organization 8 . Moreover, it corresponds to a major involvement of the government. The year 2012 was significant with advertising on the need to prevent several diseases 16 . International financing system seems to be needed for public health research.
In fact it seemed that Rwanda alone was not able to develop such research field without this international help.
Our analysis demonstrated that the main field of public health in the 86 records concerned Millenium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases) about HIV spread and mother-child transmission, so that new programs were developed to explain this transmission 17 . Moreover, the programs focused on rural provinces 3 . Within the HIV studies, violence and sexual abuse concerning women were putting forward (Millenium Development Goal 5).
Nevertheless, we thought that other subjects could be more represented, such as mental health diseases, after the genocide 18 . This area seems to be dormant and could benefit from renewed impetus and focus on re-African Health Sciences Vol 14 Issue 4, December 2014 search and publishing. It could be that they do the work but do not publish. Research on areas of health systems and Ministry of Health and Family Welfare were not available in our study and could be a limitation. Mental health seemed relevant not only because of war-related trauma, but also of disease-related trauma such as AIDS or other diseases. It seems clear that the current policies are not involved in such a field. Only four records on 86 put forward mental health. Mental health is clearly a burning issue for researchers in neighboring countries as Uganda. The studies deal with the impact of war in psychiatric problems and also with the impact of disease [19][20] . It could be explained by an historical and political points of view. In fact, in order to rebuild the country, the most urgent was not the psychiatric concerns. For the neighboring countries where most victims fled to, such as Uganda, post-traumatic disorders have become an obvious problem to take into account.
Finally, the networks between countries and the funding companies demonstrated that the public health in Rwanda, focused on HIV and mother-child transmission, since 6 years, were funded by Western organization with a major collaboration between Rwanda and the United States of America. Then, Belgium played also a major role, showing that Belgium remains still a help for Rwanda. Asian countries were not really implicated in the studies onpublichealth. European countries such as England, Switzerland or France were involved in these records. Other African countries such as Kenya, Ivory Coast, and Ethiopia were also involved. In fact, a limit of our study was the only use of SCIE database. This study was performed on this data base because the analyses were possible with the system. Suchfunctionisnotavailable withother databases. That's why we thought that the participation of other African countries might be under estimated in the Rwandan public health research.
However, the link between the United States and Rwanda in this field, even if a bias of database choice could be seen, seems clearly relevant compared to other links.

Conflicts of interest
None